Wiki Fluoroscopic Guidance - to use or not to use?

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kelly.carpenter610@gmail.com

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I'm struggling with knowing if fluoroscopic guidance is included in procedures or not. Does anyone know of a resource to check?
As an example, I am working through Practicode and just coded (correctly) 63030. The report says this was done under fluoroscopic guidance, so I coded that as well AFTER confirming in NCCI that both are allowed. Practicode marked it incorrect and didn't code the FG at all.
So...for us newbies...how do we know if it's included or not. Thank you!
 
I can't answer about Practicode - never used it, never saw it. I have heard tales of errors in Practicode. Let's assume Practicode was accurate in marking incorrect.
My surgery coding experience is only in obgyn but I'll provide some general guidance. Obviously any CPT where the description states including fluoro guidance would never be additionally coded.
Perhaps you used the wrong fluoroscopic guidance code (there are a few) or you did not put modifier -26. When radiology procedures are done in a facility, the facility gets to bill the -TC. The provider bills -26.
Another possibility is the fluoro guidance codes are add on codes. There are specific base codes that must be coded first in order to use many add on codes.
Hopefully someone with neurosurgery experience can provide additional background.
 
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I don't know about Practicode either, but I have heard a lot of gripes about it.

However, if you tried to report 76000 you may have missed a major concept called "separate procedure".
76000 has (separate procedure) designation. If you read the definition of separate procedure at the beginning of the surgery guidelines in the CPT book you will find the answer. They are considered integral and can't be reported separately.
It's rare to never that you would be able to report fluoro guidance in the course of a major surgical procedure separately.

Further, if a procedure is not (separate procedure) it's not always a P2P edit issue. It can be an NCCI guideline from the NCCI manual.
"8. Fluoroscopy reported as CPT code 76000 is integral to many proceduresincluding, but not limited, to most spinal, endoscopic, and injection procedures and shall not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes which may be reported separately. (CPT code 76001 was deleted January 1, 2019.)"

Also refer to the surgery guidelines in the CPT book before the start of the surgery section 1000_ codes. Look at the imaging guidance section.
Also refer to the radiology guidelines in the CPT book before the start of the radiology section 70010 codes. Check the Supervision, Interpretation, Imaging Guidance section.
 
amyjph said:
I don't know about Practicode either, but I have heard a lot of gripes about it.

However, if you tried to report 76000 you may have missed a major concept called "separate procedure".
76000 has (separate procedure) designation. If you read the definition of separate procedure at the beginning of the surgery guidelines in the CPT book you will find the answer. They are considered integral and can't be reported separately.
It's rare to never that you would be able to report fluoro guidance in the course of a major surgical procedure separately.

Further, if a procedure is not (separate procedure) it's not always a P2P edit issue. It can be an NCCI guideline from the NCCI manual.
"8. Fluoroscopy reported as CPT code 76000 is integral to many proceduresincluding, but not limited, to most spinal, endoscopic, and injection procedures and shall not be reported separately. For some of these procedures, there are separate fluoroscopic guidance codes which may be reported separately. (CPT code 76001 was deleted January 1, 2019.)"

Also refer to the surgery guidelines in the CPT book before the start of the surgery section 1000_ codes. Look at the imaging guidance section.
Also refer to the radiology guidelines in the CPT book before the start of the radiology section 70010 codes. Check the Supervision, Interpretation, Imaging Guidance section.
Click to expand...
Thank you very much for taking the time to reply to my post. Very much appreciate it. This isn't exactly what I am questioning, though. Practicode didn't apply a fluoroscopy guidance code at all. Just the procedure code. I applied a fluoroscopy code and the 26 on the procedure. Practicode is basically saying the FG code isn't needed at all. So, my question is....how do I know when a procedure already includes the FG if it's not clearly stated?
 
kelly.carpenter610@gmail.com said:
Thank you very much for taking the time to reply to my post. Very much appreciate it. This isn't exactly what I am questioning, though. Practicode didn't apply a fluoroscopy guidance code at all. Just the procedure code. I applied a fluoroscopy code and the 26 on the procedure. Practicode is basically saying the FG code isn't needed at all. So, my question is....how do I know when a procedure already includes the FG if it's not clearly stated?
Click to expand...
Hello,
My book has a list of primary codes that are to be used with add on codes + 77002 and + 77003. For instance, under the description for + 77003, my book has the following information:
"Code first (61050-61055, 62267, 62273, 62280-62284, 64449, 64510, 64717, 64520, 64610, 96450)"
So, if my doctor performs fluoroscopy with a procedure that is not listed in the "code first" category, then I generally don't report the fluoroscopy separately. Does that make sense?
-Ashley
 
kelly.carpenter610@gmail.com said:
Thank you very much for taking the time to reply to my post. Very much appreciate it. This isn't exactly what I am questioning, though. Practicode didn't apply a fluoroscopy guidance code at all. Just the procedure code. I applied a fluoroscopy code and the 26 on the procedure. Practicode is basically saying the FG code isn't needed at all. So, my question is....how do I know when a procedure already includes the FG if it's not clearly stated?
Click to expand...
You would know because the fluoro code has separate procedure designation and should not be reported with 63030 in this case. Practicode is correct in this instance. It is clearly stated in the description of the fluoro code 76000 because it is a (separate procedure). It is considered integral and can't be reported separately with the surgery.

77002 and 77003 would not be correct with CPT 63030 even if it was allowed.
77002 and 77003 are add-on codes for use with specific parent procedures. In contrast, 76000 is not an add-on code.
These are two different concepts.

You are on the right track trying to code everything that was stated. Wondering where you saw that there was no NCCI edit for these two codes, this is assuming you looked up 76000 w/ 63030? There is an edit and it's: STANDARDS OF MEDICAL/SURGICAL PRACTICE: This edit describes a code pair that, through analysis by regulatory bodies and physician peer review, have been determined to be necessary to complete a surgical procedure. CMS considers all services necessary to complete the comprehensive procedure as included in payment.
 
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